About the position
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. This position navigates and works within our proprietary electronic medical record system to evaluate and process patient health information to determine outcomes for various types of medical and specialty exams. You will conduct a clinical review of a variety of examination documentation, test results, assessments, and information to provide a clear, comprehensive, and concise final product. Utilizing clinical judgment, you will identify quality assurance issues and make recommendations to reconcile documentation. Collaboration with providers via the nurse call line is essential to ensure examinations meet regulatory and contractual requirements for compensation and benefit rating purposes. You must possess the ability to shift focus and multitask while maintaining a professional demeanor to meet customer and provider needs. Additionally, you will identify emergent behavioral health issues and initiate intervention when necessary. The required schedule for this position is Monday through Friday: 1:00pm to 10:00pm EST | 12:00pm to 9:00pm CST | 11:00am-8:00pm MST | 10:00AM-7:00PM PST, with rotating weekends (approximately every 8 weeks) required. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Responsibilities
- Remain up to date with the contract requirements
- Use clinical judgement to ensure a clear, comprehensive, and concise exam documentation that is reflective of the patient's service level conditions and in compliance to contract requirements
- Interpret and document diagnostic test results
- Educate and support provider with navigating and utilizing medical history information and prior disability claims when completing the appointment paperwork
- Answer calls that come into the Clinical Operations Review queue regarding medical or specialty exams and provide exemplary service to providers with appointment questions
- Identify and evaluate exam documentation that requires immediate follow up for behavioral health issues and initiate the high-risk intervention process
- Complete system generated tasks to process exam documentation
- Interface via telephone and e-mail with contracted providers in retrieval of required Disability Benefits Questionnaire information and provide education regarding required contractual protocol
Requirements
- Accredited Associate's Degree in Nursing (ADN) OR Bachelor's Degree in Nursing (BSN)
- Current RN license in your state of residency
- 2+ years of experience in a clinical environment as a Registered Nurse
- Experience working in an Electronic Medical Record system
- Understanding/knowledge of regulatory standards and their application to various examinations and documents
- Proficient computer skills including Microsoft Office programs and database experience
- Ability to work rotating weekends (approximately every 8 weeks)
- Distraction-free, dedicated space in home for home office
- Access to high-speed internet (cable, fiber optic)
Nice-to-haves
- Experience in an Intensive Care Unit or Emergency Room
- Prior authorization, utilization management/review experience
- Experience reviewing medical disability claims
- Knowledge or experience in: Clinical quality assurance, Auditing and compliance, Education of clinical staff, Clinical documentation improvement
- Clinical experience: Neurological, Cardiovascular or Respiratory units
- ISO 9001 standards
- Healthcare regulatory and accreditation standards
- Experience with Behavioral Health, TBI, PTSD and/or working with Veterans
- Military experience
- Proven ability to collaborate with providers to ensure quality patient outcomes
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
